Resuscitation
-
LUCAS is a new device for mechanical compression and decompression of the chest during cardiopulmonary resuscitation (CPR). The aim of this study was to compare the efficacy of this new device with standard manual external chest compressions using cerebral cortical blood flow, cerebral oxygen extraction, and end-tidal CO2 for indirect measurement of cardiac output. Drug therapy, with adrenaline (epinephrine) was eliminated in order to evaluate the effects of chest compressions alone. ⋯ Chest compressions with the LUCAS device during experimental cardiopulmonary resuscitation resulted in higher cerebral blood flow and cardiac output than standard manual external chest compressions. These results strongly support prospective randomised studies in patients to evaluate this new device.
-
Hypothermia < 28 degrees C is rarely compatible with life, with only a few cases described surviving such low temperatures. We present a case of a man who survived with a core body temperature below 21.0 degrees C after spending a night in a snowbank with an ambient temperatures as low as -20.0 degrees C. Prolonged CPR and early initiation of extracorporeal membrane oxygenation enabled survival without neurological deficit at hospital discharge. Frostbite was limited to both hands and all toes only; although the entire upper and lower extremity appeared to be deeply frozen on admission, amputation of both hands was inevitable and resulted in permanent disability.
-
Comparative Study
A comparison of CPR delivery with various compression-to-ventilation ratios during two-rescuer CPR.
The number of chest compressions required for optimal generation of coronary perfusion pressure remains unknown although studies examining compression-to-ventilation ratios higher than 15:2 (C:V) in animals have reported higher C:V to be superior for return of spontaneous circulation and neurologic outcome. We examined human performance of two-rescuer CPR using various C:V. ⋯ A 15:2 compression-to-ventilation ratio when performed during two-rescuer CPR results in 26s of hands off time each minute while only delivering 60 compressions. Alternative C:V ratios of 30:2, 40:2, 50:2, and 60:2 all exceed the AHA recommended 80 compressions/min while still delivering a minute volume in excess of 1l.
-
To examine the relationship between key patient variables and variation in naloxone dose (from the standard dose of 1.6 mg IMI) administered by ambulance paramedics in the prehospital management of heroin overdose. ⋯ The concurrent use of alcohol with heroin resulted in the use of greater than standard doses of naloxone by paramedics in resuscitating overdose patients. It is possible that the higher dose of naloxone is required to reverse the combined effects of alcohol and heroin. There was also a link between initial patient presentation and the dose of naloxone required for resuscitation. In light of these findings, it would appear that initial patient presentation and evidence of alcohol use might be useful guides as to providing the most effective dose of naloxone in the prehospital setting.
-
Our goal was to evaluate the details and management of cardiac arrest (CA) occurring in the working environment. ⋯ Although our study did not support that concept that the workplace was a safer place, there was a better chain of survival for CA applied within workplace settings. Basic Life Support teaching and installation of AEDs could be helpful, though further cost-effectiveness studies are needed.